Severe Maternal Morbidity Among Pregnant People With Opioid Use Disorder Enrolled in Medicaid.

Importance: Pregnant people with opioid use disorder (OUD) are at high risk for potentially avoidable maternal morbidity. The majority of pregnant people with OUD receive health insurance through state Medicaid programs, but there is little comprehensive data on the burden of severe maternal morbidity (SMM)-a composite measure of adverse maternal health outcomes-among this high-risk group.

Objective: To estimate rates of SMM among Medicaid-enrolled pregnant people with OUD from 2016 to 2018.

Opioid misuse and mental health in college student populations: A national assessment.

Background: Despite growing concern about opioid misuse and mental health of college students, little is known about this population who are at high risk of co-occurrence and unmet needs. This national study aims to estimate the prevalence of opioid misuse, examine correlates with anxiety and depression symptoms, and quantify help-seeking behaviors among U.S.

Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System.

Objective: To evaluate the performance of different approaches for identifying live births using Transformed Medicaid Statistical Information System Analytic Files (TAF).

Data Sources: The primary data source for this study were TAF inpatient (IP), other services (OT), and demographic and eligibility files. These data contain administrative claims for Medicaid enrollees in all 50 states and the District of Columbia from January 1, 2018 to December 31, 2018.

Excess Mortality at Veterans Health Administration Facilities During the COVID-19 Pandemic.

Importance: The COVID-19 pandemic resulted in excess mortality among the general US population and at Veterans Health Administration (VHA) facilities. It is critical to understand the characteristics of facilities that experienced the highest and lowest pandemic-related mortality to inform future mitigation efforts.

Objective: To identify facility-level excess mortality during the pandemic and to correlate these estimates with facility characteristics and community-wide rates of COVID-19 burden.

Using Modernized Medicaid Data to Advance Evidence-Based Improvements in Maternal Health.

Medicaid is the primary payor for nearly half of all births in the United States and plays a disproportionate role in covering maternity care for low-income people, rural people, and minoritized racial groups. Newly available, modernized Medicaid claims data-the Transformed Medicaid Statistical Information System Analytic Files (TAF)-offer a significant opportunity to conduct novel research that can drive the development of evidence-based programs and policies for Medicaid beneficiaries before, during, and after pregnancy. Yet, the public health research community has so far underused the TAF for maternal health research.

State Variation in Severe Maternal Morbidity Among Individuals With Medicaid Insurance.

Objective: To measure variation in delivery-related severe maternal morbidity (SMM) among individuals with Medicaid insurance by state and by race and ethnicity across and within states.

Methods: We conducted a pooled, cross-sectional analysis of the 2016-2018 TAF (Transformed Medicaid Statistical Information System Analytic Files). We measured overall and state-level rates of SMM without blood transfusion for all individuals with Medicaid insurance with live births in 49 states and Washington, DC.

Mental health service use in a national sample of college students with co-occurring depression or anxiety and substance use.

Introduction: Campus health systems can provide timely and accessible resources for students with co-occurring substance use and mental illness, but little is known about the degree to which students use these systems. This study examined mental health service utilization among students with symptoms of anxiety or depression, stratified by substance use.

Methods: This cross-sectional study used data came from the 2017-2020 Healthy Minds Study.

Effect of a Veterans Health Administration mandate to case review patients with opioid prescriptions on mortality among patients with opioid use disorder: a secondary analysis of the STORM randomized control trial.

Aims: The Veterans Health Administration (VHA) implemented the Stratification Tool for Opioid Risk Mitigation (STORM) to reduce the risk of serious adverse events (SAE) among patients with opioid analgesic prescriptions. VHA facilities were mandated to case review patients identified as high risk by STORM. The aim of this study was to measure the effect of this mandate on all-cause mortality and SAEs among VHA patients newly diagnosed with opioid use disorder (OUD).

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic.

Background: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities.

Objective: To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status.

Research Design: We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends.

Association Between Medicaid Managed Care Coverage of Substance Use Services and Treatment Utilization.

Importance: Medicaid insures a disproportionate share of adults with substance use disorder (SUD) and is thus uniquely positioned to facilitate access to care. Many enrollees receive coverage through Medicaid managed care (MMC) plans, which receive capitated payments in exchange for coverage of a defined set of benefits. Historically, coverage of substance use services has been carved out of MMC plans and financed fee-for-service (FFS) by state Medicaid programs, but in recent years, many states have opted to carve in this benefit.

Association of Medicaid Managed Care Drug Carve Outs With Hepatitis C Virus Prescription Use.

Importance: Medicaid enrolls a disproportionate share of US adults with hepatitis C virus (HCV), and most receive Medicaid benefits through managed care organizations (MCOs). Medicaid MCOs often impose stricter requirements to access HCV medications than traditional fee-for-service Medicaid, which may inhibit use. Though Medicaid MCOs generally cover prescription drugs, several states have carved out direct-acting antiviral HCV medications from MCO coverage and opted to cover them under fee-for-service.

Medicaid Subscription-Based Payment Models and Implications for Access to Hepatitis C Medications.

Importance: Hepatitis C virus (HCV) can be cured with direct-acting antiviral medications, but state Medicaid programs often restrict access to these lifesaving medications owing to their high costs. Subscription-based payment models (SBPMs), wherein states contract with a single manufacturer to supply prescriptions at a reduced price, may offer a solution that increases access. Whether SBPMs are associated with changes in HCV medication use is unknown.

Improving Access to High-Value, High-Cost Medicines: The Use of Subscription Models to Treat Hepatitis C Using Direct-Acting Antivirals in the United States.

State payers may face financial incentives to restrict use of high-cost medications. Yet, restrictions on access to high-value medications may have deleterious effects on population health. Direct-acting antivirals (DAAs), available since 2013, can cure chronic infection with hepatitis C virus (HCV).

Trends Among Female Pelvic Medicine and Reconstructive Surgery Fellowships and Graduates.

Importance: Understanding differences in female pelvic medicine and reconstructive surgery (FPMRS) urology and gynecology-based fellowships is important because both are accredited by the American Board of Medical Subspecialties.

Objective: The aim of the study was to characterize urology-based and gynecology-based FPMRS fellowships.

Material And Methods: An institutional review board-approved 21-item survey was emailed to Accreditation Council for Graduate Medical Education-accredited FPMRS fellowship program directors from January 8 through March 9, 2021.

Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.

Background: The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status.

County-Level Impact of the COVID-19 Pandemic on Excess Mortality Among U.S. Veterans: A Population-Based Study.

Background: As the novel coronavirus (COVID-19) continues to impact the world at large, Veterans of the US Armed Forces are experiencing increases in both COVID-19 and non-COVID-19 mortality. Veterans may be more susceptible to the pandemic than the general population due to their higher comorbidity burdens and older age, but no research has examined if trends in excess mortality differ between these groups. Additionally, individual-level data on demographics, comorbidities, and deaths are provided in near-real time for all enrolees of the Veterans Health Administration (VHA).

County-level data on U.S. opioid distributions, demographics, healthcare supply, and healthcare access.

The dataset summarized in this article is a combination of several of U.S. federal data resources for the years 2006-2013, containing county-level variables for opioid pill volumes, demographics (e.

Implications of county-level variation in U.S. opioid distribution.

Background: Prescription opioids accounted for the majority of opioid-related deaths in the United States prior to 2010, and continue to contribute to opioid misuse and mortality. We used a novel dataset to investigate the distributional patterns of prescription opioids, whether opioid pill volume was associated with opioid-related mortality, and whether early state Medicaid expansions were associated with either pill volume or opioid-related mortality.

Methods: Data on opioid shipments to retail pharmacies for 2006-2013 were obtained from the U.

Buprenorphine waiver uptake among nurse practitioners and physician assistants: The role of existing waivered prescriber supply.

Background: Buprenorphine is an effective pharmacotherapy for the treatment of opioid use disorder (OUD), but recent increases in the rate of OUD in the U.S. have outpaced the supply of clinicians waivered to prescribe buprenorphine.

Singleton, Term, Vertex Cesarean Delivery on a Midwife Service Compared With an Obstetrician Service.

Objective: To evaluate the difference in odds of cesarean delivery in term, singleton, vertex pregnancies between the midwife and obstetrician-led services at the same rural tertiary care center.

Methods: A retrospective cohort study of term, singleton, and vertex deliveries in patients without a history of cesarean delivery was performed. Patients self-selected a delivery service.

Emerging Trends in Cannabis Administration Among Adolescent Cannabis Users.

Purpose: The legal landscape of cannabis availability and use in the United States is rapidly changing. As the heterogeneity of cannabis products and methods of use increases, more information is needed on how these changes affect use, especially in vulnerable populations such as youth.

Methods: A national sample of adolescents aged 14-18 years (N = 2,630) were recruited online through advertisements displayed on Facebook and Instagram to complete a survey on cannabis.